Provider Demographics
NPI:1730205634
Name:COMMUNITY HEALTH DEVELOPMENT, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH DEVELOPMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-278-5604
Mailing Address - Street 1:908 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6034
Mailing Address - Country:US
Mailing Address - Phone:830-278-5604
Mailing Address - Fax:830-278-1836
Practice Address - Street 1:121 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:LEAKEY
Practice Address - State:TX
Practice Address - Zip Code:78873-3164
Practice Address - Country:US
Practice Address - Phone:830-232-6985
Practice Address - Fax:830-232-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXZ00FM205261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FM20OtherMEDICARE TRAILBLAZER
TX111438105Medicaid
TX451878Medicare PIN
TX111438105Medicaid